Evaluation of a direct test for seasonal influenza in outpatients

Theocharis, George; Vouloumanou, Evridiki K.; Rafailidis, Petros I.; Spiropoulos, T.; Barbas, S. G.; Falagas, Matthew E.

doi:10.1016/j.ejim.2010.06.013

Cited by 8 publications

(10 citation statements)

References 31 publications

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“…In addition to comparing POCT and standard testing, three of the studies also assessed differences between positive and negative POCT results, demonstrating that patients positive for influenza by POCT were significantly less likely to receive antibiotics. Eight other studies (30.8%) reported similar findings. There were six (23.1%) studies that found no significant changes in antibiotic prescription with POCT use …”

Section: Resultssupporting

confidence: 64%

“…Likewise, Li‐Kim‐Moy et al (46.2% vs 21.5%, P = 0.001); Blaschke et al (56% vs 19%, P = 0.002); and Jennings et al (60.1% vs 24.6%, 4618/7658 vs 178/725) all reported that influenza positive patients had significantly increased antiviral use amongst those diagnosed by a POCT compared with standard testing. Blaschke et al also demonstrated antiviral prescription was significantly higher in patients who received a positive POCT result in comparison with a negative POCT result (56% vs 2%, P < 0.0001), as did Suryaprasad et al (57% vs 18%, 48/84 vs 37/206) and Theocharis et al (76.2% vs 1.1%, P < 0.01). One study of treatment outcomes showed that patients who were prescribed oseltamivir only were significantly more likely to have been diagnosed by POCT compared with patients receiving antibiotics only, antibiotic/antiviral combination, or supportive care.…”

Section: Resultsmentioning

confidence: 74%

“…A positive result may eliminate unnecessary antibiotic prescription, whilst a negative POCT result may allow a bacterial infection to be treated promptly. This was evident in the 11 studies included in this review, which demonstrated that a positive POCT diagnosis led to decreased antibiotic use compared with a negative POCT result . Shortening or eliminating avoidable antibiotic use can be of benefit by reducing risk from antibiotic resistance on both a patient and large‐scale level.…”

Section: Discussionmentioning

confidence: 91%

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Systematic review of the impact of point‐of‐care testing for influenza on the outcomes of patients with acute respiratory tract infection

Egilmezer

Walker

Bakthavathsalam

et al. 2018

Reviews in Medical Virology

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Acute respiratory tract infections are a major cause of morbidity and mortality and represent a significant burden on the health care system. Laboratory testing is required to definitively distinguish infecting influenza virus from other pathogens, resulting in prolonged emergency department (ED) visits and unnecessary antibiotic use. Recently available rapid point-of-care tests (POCT) may allow for appropriate use of antiviral and antibiotic treatments and decrease patient lengths of stay. We undertook a systematic review to assess the effect of POCT for influenza on three outcomes: (1) antiviral prescription, (2) antibiotic prescription, and (3) patient length of stay in the ED. The databases Medline and Embase were searched using MeSH terms and keywords for influenza, POCT, antivirals, antibiotics, and length of stay. Amongst 245 studies screened, 30 were included. The majority of papers reporting on antiviral prescription found that a positive POCT result significantly increased use of antivirals for influenza compared with negative POCT results and standard supportive care. A positive POCT result also led to decreased antibiotic use. The results of studies assessing the effect of POCT on ED length of stay were not definitive. The studies assessed in this systematic review support the use of POCT for diagnosis of influenza in patients suffering an acute respiratory infection. Diagnosis using POCT may lead to more appropriate prescription of treatments for infectious agents. Further studies are needed to assess the effect of POCT on the length of stay in ED.

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Section: Resultssupporting

confidence: 64%

Section: Resultsmentioning

confidence: 74%

Section: Discussionmentioning

confidence: 91%

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Systematic review of the impact of point‐of‐care testing for influenza on the outcomes of patients with acute respiratory tract infection

Egilmezer

Walker

Bakthavathsalam

et al. 2018

Reviews in Medical Virology

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“…A subset of the patients in the first study period were included in a recent publication focusing on the impact that the introduction of the direct influenza had on the decision-making, particularly the prescribing pattern of the network of SOS Doctors (7).…”

Section: Patient Populationmentioning

confidence: 99%

“…In particular, published reports have suggested that younger age groups were predominantly affected by the 2009 H1N1 pandemic influenza (1-3), whereas pregnant and obese patients constituted a considerable percentage among more severely afflicted 2009 H1N1 pandemic influenza cases (including hospitalised and cases admitted in the intensive care unit), as well as among fatalities (2)(3)(4). With regard to influenza diagnosis, published evi-dence suggests that the use of direct influenza tests during seasonal influenza periods has been associated with reduced unnecessary antibiotic prescriptions, hospitalisations and laboratory tests (5)(6)(7). However, the experience of their use during the pandemic period was rather disappointing, as the sensitivities reported in studies evaluating its application in various clinical settings were considered suboptimal (8)(9)(10).…”

Section: Introductionmentioning

confidence: 99%

Comparison of characteristics of outpatients with 2009 H1N1 pandemic and seasonal influenza

Theocharis¹,

Vouloumanou²,

Barbas³

et al. 2011

International Journal of Clinical Practice

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Summary Background: The latest influenza pandemic intensified the interest in this infection. Objective: We aimed to compare the characteristics of outpatients with seasonal and pandemic influenza. Methods: We retrospectively reviewed data regarding outpatients who sought medical advice from a network of physicians performing house‐call visits at the area of Attica, Greece, and who underwent a direct influenza test during the period of seasonal influenza (1/1/2009–1/5/2009) and 2009 H1N1 pandemic influenza period (17/5/2009–15/4/2010). Results: A total of 195 and 1317 patients had a direct influenza test during the seasonal and pandemic influenza period, respectively; 50.7% and 32% of these patients had a positive test result for influenza, respectively. Viral culture or polymerase chain reaction (PCR) were not implemented. Patients found positive for influenza during the pandemic period, compared with those evaluated during the seasonal period, were younger (mean age ± SD: 33 ± 17.2 vs. 38.2 ± 19.2, p = 0.008), more likely to have no comorbidity (62.9% vs. 45.5%, p = 0.002), had milder clinical manifestations, and were treated with more antibiotics (38.3% vs. 9.9%, p < 0.001). However, patients found positive during the seasonal period were treated with more antivirals (oseltamivir: 69.1% vs. 85.7%, p = 0.006). No difference was observed regarding the need for immediate hospitalisation. These findings were consistent in the complementary analysis involving patients tested for influenza during the compared periods. Conclusion: Despite the methodological limitations, our findings suggest that patients with pandemic influenza were younger, had milder clinical manifestations and were less likely to have any kind of comorbidity compared with patients with seasonal influenza.

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Impact of oseltamivir use on the reduction of complications in patients with influenza: a prospective study

Vardakas

Theocharis²,

Tansarli

et al. 2016

Arch Virol

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To evaluate the factors associated with oseltamivir prescription and to study the effectiveness of oseltamivir in reducing influenza-related complications. A prospective cohort study using the SOS Doctors (a network of physicians who perform house-call visits in Attica, Greece). Patients with confirmed or clinically suspected influenza were followed up to 14 days during the 2011-2012 influenza period. 410 patients with confirmed or suspected influenza were included. Healthy adults were mainly enrolled, with a median age of 44 years. Influenza diagnosis was mainly based on clinical criteria (65.8 % of patients). Oseltamivir was prescribed for 45.4 % of them. In a multivariate analysis, prescription of oseltamivir was associated with the attending physician (p < 0.001), positive influenza test (p < 0.001) and diabetes (p = 0.027). Data on complications were available for 351 patients, and 50 (15.8 %) of them reported at least one. Seven patients required hospitalization. Types of complications (pneumonia, bronchitis, etc.) were not significantly different between patients receiving and those not receiving oseltamivir. In the multivariate analysis, higher oseltamivir prescription rate was associated with fewer complications (p < 0.001). Bearing in mind the limitations of a non-randomized study, in a real-life setting, oseltamivir prescription and the rate of complications in patients with influenza were associated with the attending physician, underlying diseases and diagnostic tests. Overall, when the frequency of oseltamivir prescription increased, the influenza-related complications decreased.

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Evaluation of a direct test for seasonal influenza in outpatients

Cited by 8 publications

References 31 publications

Systematic review of the impact of point‐of‐care testing for influenza on the outcomes of patients with acute respiratory tract infection

Systematic review of the impact of point‐of‐care testing for influenza on the outcomes of patients with acute respiratory tract infection

Comparison of characteristics of outpatients with 2009 H1N1 pandemic and seasonal influenza

Impact of oseltamivir use on the reduction of complications in patients with influenza: a prospective study

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